A review of Wagner classification and current concepts in management of diabetic foot

Abstract

Diabetic foot is a common complication of diabetes mellitus which affects 15% of diabetic patients in their lifetime. Effective management of diabetic foot can reduce severity of complications such as preventable amputations and possible mortality, and can also improve overall quality of life. The Wagner classification is most commonly used for grading diabetic foot ulcers. Wagner developed a classification system and a treatment algorithm for each grade of ulcer. He asserted that ischemic index derived from Doppler flow pressures is an essential baseline test to predict ulcer healing. The aim of this study was to evaluate and manage different lesions of diabetic foot according to Wagner classification. We propose a treatment-oriented assessment of diabetic foot ulcers based on a cross-examination of the medical, foot, and wound history; a systemized and detailed physical examination; and the results of complementary diagnostic procedures. The pathophysiology and treatment of diabetic foot ulcers are reviewed. While these guidelines cannot dictate the care of all affected patients, they provide evidence based guidance for general patters of practice.